What They Are because of a change in circumstance, such as a loss of coverage through another plan. If your browser does not support Javascript or Javascript is disabled, please click the "Calculate" button below. Demographic Data Self-Identification Form, For all Employees in titles allocated or equated to Salary Grade 9 and below*, For all Employees in titles allocated or equated to Salary Grade 10 and above*. Monthly LWOP and YAO Premium COBRA Monthly Premium Individual Coverage ; . This year's Option Transfer Period will run from December 1-30, 2022. the dollar amount is not limited by the cost of Empire Plan drug coverage. For example, during 2015, individual coverage under NYSHIP costs $805.05 per month. * The Maximum In-Network Out-of-Pocket (OOP) Limit is the most you will pay out of your own pocket in a given plan year for covered health NOTE: Information about the cost of this plan (called the premium) will be provided separately. Choices Explains Your Health Plan Options You may change options more than once in a 12-month period only if: State's share and your share of the cost of coverage are based on the following: * Or salary equivalent, if no Grade assigned. If you do not have internet access, call 1-877-7-NYSHIP (1-877-769-7447) and select the Medical/Surgical Program to request a copy for The Empire Plan. Select the Medical/Surgical Program and then the appropriate prompt for assistance with option transfer benefit questions. Please visit the appropriate links below for more information about or to enroll for Health Insurance benefits. NYSHIP Plan Comparison tool. Enter the Total Number of Individual Enrollees in of Empire Plan drug coverage. Select the Medical/Surgical Program and then the appropriate prompt for option transfer benefit questions. provides a more detailed comparison of NYSHIP benefits, including The Empire Plan and NYSHIP-approved HMOs, as well as the procedures for changing options. is disabled, please click the "Calculate" button below. The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. for in-network expenses incurred under the Prescription Drug Program is $3,000 for Individual coverage and $6,000 for Family coverage for both the Empire and Excelsior Plans. The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. The annual cost for Empire Plan Family coverage ranged from $20,570 to $28,953 during . for the remainder of the plan year. plans in your area using the online NYSHIP Plan Comparison tool. Your current plan will notify you directly if there are any copayment or benefit changes for 2020. The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447 . If you have questions about The Empire Plan, call toll free at 1-877-7-NYSHIP (1-877-769-7447). The annual Option Transfer Period for State employees will begin Thursday, December 1, 2022, and end Friday, December 30, 2022 . For more information, visit www.medicare.gov. Employees, retirees and their families from: New York State Agencies Participating Employers Participating Agencies Today's Topics Eligibility Cost Sick Leave Credit Dental and Vision Eligible Dependents Dependent Survivors Medicare Just 1 copayment of $25 is required for all covered office visits, office surgery, radiology and/or laboratory services received by the same enrollee from the same provider on the same date of service. For questions about your benefits for medical devices, including CPAP machines, you can also call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and choose the Medical/Surgical Program, then the Benefits Management Program to reach the Home Care Advocacy Program (HCAP). NYSHIP offers several coverage options, including Individual and Family coverage. 2022 NYSHIP OPTIONS BY COUNTY Please use this listing to locate the available NYSHIP options for each county in New York State. The 2023 Maximum In-Network OOP Limits for the HMOs participating in NYSHIP vary by plan and may be viewed in Health Insurance Choices for 2023. See page 3 for more information. Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2022 - 12/31/2022 The Empire Plan: NYS Health Insurance Program - Settled Groups, PA (Empire Plan), PE & NY Retiree Coverage for: Individual/Family | Plan Type: PPO 2023 Empire Plan Maximum In-Network OOP Limits. The 2023 Empire Plan deductible amounts may be viewed in Health Insurance Choices for 2023. Family Coverage $11,800 for in-network expenses incurred under . New York State helps to pay for your health insurance coverage. 001 454.22 The Empire Plan 1,123.20 986.85 2,440.27 1,006.59 2,489.08 Dependent Survivor Cost Individual Family Dual Annuitant Sick Leave Credit Option 10% of cost of Individual coverage 10% of cost of Individual coverage plus 25% of cost of dependent . It is updated weekly. Note: this rate is based on the Base Medicare Reimbursement Rate. State and participating organization employers and members pay their respective share of those premiums. For questions about The Empire Plan, call toll free at 1-877-7-NYSHIP (1-877-769-7447). * UUP Employees with an annualized salary of less than $47,024 are considered to be salary grade 9 and below while UUP employees with an annualized salary of $47,024 or more are considered to be salary grade 10 and above. E.g., an employee gets married on June 10th, and applies for family coverage on July 11; the coverage for the spouse will become effective on October 1st. Once you reach this limit, your copayments will be reimbursed by your plan 2023 Deductible Amounts There is a nationwide network of more than 1.2 million UnitedHealthcare Empire Plan participating providers, including over 70,000 Managed Physical Network (MPN) providers for chiropractic care and physical therapy. The Empire Plan: NYS Health . P.O. . The premium is the full cost for individual coverage. The 2023 NYSHIP health plan rates for Active employees of the State of New York and their enrolled dependents are posted below. For 2022, the maximum out-of-pocket limit for covered, in-network services under The Empire Plan is $8,700 for Individual coverage and $17,400 for Family coverage, split between the Hospital, Medical/ Surgical, Mental Health and Substance Use and Prescription Drug Programs. If you have questions about The Empire Plan, call toll free at 1-877-7-NYSHIP (1-877-769-7447). You can reach the Clinical Referral Line by selecting option 3 from the MHSU Program menu. Currently, the State pays 84-88% of the cost of individual coverage and 69-73% of the additional cost for family coverage in the NYS Empire Plan. NYSHIP Empire Plan Rates Effective July 1, 2023 . This is only a summary. Call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and press or say 3 to reach the Mental Health and Substance Use Program. This is a listing of 2022 biweekly premium contributions for enrollees in The Empire Plan and NYSHIP-approved HMOs, as well as deadlines for making The State's dollar contribution for the non-prescription drug components of the HMO premium, however, will not exceed its dollar contribution for the non-prescription drug components of The Empire Plan premium. 2021 NYSHIP Benefit Plan Comparison Program The Empire Plan The Excelsior Plan . You may enroll in The Empire Plan or a NYSHIP-approved HMO that serves the area where you live or work. General Information Book for Active Employees, Retirees, Vestees and Dependent Survivors of NYSHIP Participating Agencies with The Empire Plan or the Excelsior Plan and their Eligible Dependents. Participating Employers (PEs) will notify their enrollees of 2023 rates. (2), you are requesting a change of coverage to family due to the birth of a child. February 3 . The annual Option Transfer Period is here. This does not apply to Medicare-primary Empire Plan enrollees and their covered dependents. 1-877-7-NYSHIP (1-877-769-7447) and select option 4 for the Empire Plan Prescription Drug Program. $135.50 * x (Enter total # of Medicare Primary Enrollees and Dependents ) =. out-of-pocket costs. care services delivered by in-network providers under your plan. no cost when you use a Plan participating provider or network facility. This is the time to choose the health insurance option you want for 2023. Coinsurance is a fixed percentage of the cost of the service being received. The Empire Plan NYSHIP-approved Health Maintenance Organizations (HMOs) Who is eligible for NYSHIP? If you need an SBC for a NYSHIP HMO, contact the HMO. If you enroll in a NYSHIP HMO, the State's dollar contribution for the hospital, medical/surgical and mental health and substance use You may not be enrolled in an HMO outside your area. If your browser does not support Javascript or Javascript Please note that up to 2 copayments of $30 (for a total of $60) may apply for services at an urgent care center. Under the Young Adult Option, you or your young adult child will pay a separate premium for coverage. Your current plan will notify you directly if there are any copayment or benefit changes for 2021. Rates & Deadlines for 2022. terminate your NYSHIP (Empire Plan and Medicare Advantage Plans) benefits Call EBD if you have any questions. February 3, 2022 51 Questions 51. prescription drug component of your HMO premium, the State pays the share noted in the table; the dollar amount is not limited by the cost *NYS EMPIRE PLAN: GRADE 9 or BELOW Individual $ 54.51 Family $ 235.13 GRADE 10 or ABOVE Individual $ 72.68 Family $ 280.06 *HMO BLUE: GRADE 9 or BELOW Individual $ 49.00 Family $ 206.60 GRADE 10 or ABOVE Individual $ 65.33 Family $ 246.29 *MVP: GRADE 9 or BELOW Individual $ 56.36 The 2023 NYSHIP health plan rates for Active employees of the State of New York and their enrolled dependents are posted below. * Note: You may have enrollees subject to Income - Related Medicare Adjustment Amount (IRMMA). The amount of money you are expected to pay upon receiving covered services under your health insurance plan is referred to as either a copayment or coinsurance. The New York State Health Insurance Program (NYSHIP) offers you the choice of The Empire Plan or a NYSHIP-approved Health Maintenance Organization (HMO) serving the area where you live or work. Whether you enroll in The Empire Plan or a NYSHIP HMO, the Each Coverage Type, Demographic Data Self-Identification Form, $2.493 x Total Enrollees as Reported Above =. Specific coverage provisions and plan design vary by health insurance plan and by employee bargaining unit. The Department of Civil Service (Civil Service) is responsible for administering NYSHIP and determines NYSHIP's administrative policies and procedures. This program offers a PPO, known as the Empire Plan, and several different HMOs, varying by geographic region around the State. Code Plan Individual Family Individual Family Individual Family . Note: This information does not apply to employees of Participating Employers (PEs will provide premium information), COBRA enrollees, Young Adult Option enrollees or enrollees in Leave Without Pay status (who pay the full cost of coverage). . The annual cost for Empire Plan Family coverage ranged from $20,570 to $28,953 during the audit period. After the State's contribution, you are responsible for paying the balance of Keep Your Information Up To Date In an emergency, go to the your premium, usually through biweekly deductions from your paycheck. The Empire Plan is the primary health benefits plan for NYSHIP, providing coverage to about 1.1 million members. If you want to change your option for the 2023 plan year, you must complete and submit your form(s) by the December 30th deadline. Call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and press or say 3 to reach the Biweekly Premium . For questions about NYSHIP HMOs, contact the HMOs directly (see pages 6 and 7). * Does not apply to Medicare-primary enrollees. The annual Option Transfer Period is here. Family: 13: 001: The Empire Plan: 56.01: 241.79: 74.68: 287.98: 24: 066: Blue Choice: 43.18: 184.91: 57.57: . pay 84 percent of the cost of the premium for individual coverage and 69 percent for the additional cost of family coverage. This online directory lists The Empire Plan's Participating providers. Select the Medical/Surgical Program and then NYSHIP HMOs do not have annual deductibles. Also includes information regarding COBRA continuation coverage and the Young Adult Option. 2019 Participating Agency Empire Plan Cost Estimate Calculator. components of your HMO premium will not exceed its dollar contribution for those components of The Empire Plan premium. See the 2023 Empire Plan Preventive . The dollar amount you are required to pay before a health plan begins to reimburse for covered services received from non-network providers. What It Is Note: This information does . The Clinical Referral Line is available 24 hours a day, every day of the year. See the 2023 State NYSHIP Enrollee Biweekly Premium ContributionsSee NYS Department of Civil Services NYSHIP Rates and Deadlines publication. E.g. The New York State Health Insurance Program (NYSHIP) offers you the choice of The Empire Plan or a NYSHIP-approved Health Maintenance Organization (HMO) serving the area where you live or work. What It Is A copayment is a fixed dollar amount that has been set for the service being received, regardless of the total cost of the service. Contact your HBA to confirm. All insurance plans are required to produce a Summary of Benefits and Coverage based on a uniform template and customized to reflect the plan's unique terms. If The Empire Plan is primary for you or your covered dependents, you must call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and choose the Hospital Program (administered by Empire BlueCross): Before a scheduled (nonemergency) hospital admission, skilled nursing facility admission/transfer or transplant surgery. For the Empire Plan benefits include inpatient and outpatient hospital coverage, medical/surgical coverage, Centers of Excellence for transplants, infertility and cancer, home care services, equipment and supplies, mental health and substance abuse coverage and prescription drug coverage. For more information about your coverage, or to get a copy of the complete terms of coverage, visit www.cs.ny.gov or call 1-877-7-NYSHIP . Box 30006, Pittsburgh, PA 15222-0330 2022 Summary of Benefits Empire Plan Medicare Rx sponsored by the New York State Health Insurance Program (NYSHIP) Medicare Prescription Drug Plan (PDP) offered by SilverScript Insurance Company with a Medicare contract January 1, 2022 - December 31, 2022 Y0001_GRP_3926_2022_M_NYSHIP_9482_2632_811 Your HBA, usually located in your agency's personnel office, can also print you . If you need a paper copy, call 1-877-7-NYSHIP (1-877-769-7447) and select the Medical/Surgical Program. 20 You will be responsible for the full cost of non-formulary medications and products that are excluded from coverage unless a request for a medical exception is approved. This is the time to choose the health insurance option you want for 2022. If you are enrolled in an HMO, the State will pay 84-88% for individual coverage and 69-73% for family coverage, not to exceed the dollar amount it pays for the Empire Plan. The New York State Health Insurance Program (NYSHIP) offers you the choice of The Empire Plan or a NYSHIP-approved Health Maintenance Organization (HMO) serving the area where you live or work.
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